Epidemiological trends and predictive factors of adolescent scoliosis in qingdao: insights from a Large-scale screening program (2022-2024)

Abstract

Background: Adolescent idiopathic scoliosis (AIS) is a systemic musculoskeletal disorder characterized by a three-dimensional curvature of the spine. It often progresses silently during puberty and can have significant physical and psychological consequences for affected adolescents. Early detection through school-based screening is vital for timely intervention, yet region-specific epidemiological data from northern coastal China remain limited.

Methods: This school-based cross-sectional study screened 57,393 students from grades 3 to 9 in Qingdao City between 2022 and 2024. Standardized assessments included postural observation, the Adams forward bending test, angle of trunk rotation (ATR) measurement, and plantar scanning for foot deformities. Students with ATR ≥ 5° were referred for radiographic evaluation, and scoliosis was confirmed by Cobb angle > 10° on standing full-spine X-rays.

Results: A modest but consistent decline in postural abnormality prevalence was observed over three years, with Adams test positivity decreasing from 4.5 to 4.3%. Peak ATR positivity occurred in students aged 11-13, particularly age 12. Female sex and right-sided rib hump were significantly associated with higher ATR and scoliosis severity. Among 370 students undergoing radiographs, ATR showed a strong correlation with Cobb angle (R = 0.65, p < 0.001). The majority had Cobb angles of 10-20°, with severe curves (> 20°) predominantly observed in older female students.

Conclusion: This study highlights the stable yet concerning prevalence of scoliosis in coastal northern China and validates the utility of a stepwise screening approach centered on ATR. Age, sex, and rib hump laterality are key risk indicators. Findings support targeted early screening and intervention strategies tailored to high-risk adolescent groups.

Keywords: Adolescent idiopathic scoliosis; Angle of trunk rotation; Cobb angle; Foot deformities; School-based screening.